Healthcare Provider Details

I. General information

NPI: 1982510780
Provider Name (Legal Business Name): NICOLE R WHITMORE TAYLOR CPT 1
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 W 74TH ST
LOS ANGELES CA
90044-6116
US

IV. Provider business mailing address

713 W 74TH ST
LOS ANGELES CA
90044-6116
US

V. Phone/Fax

Practice location:
  • Phone: 310-280-8585
  • Fax:
Mailing address:
  • Phone: 310-280-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberCPT-02442479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: